School of Shock

A resident at the Rotenberg Center for 18 years, Matthew Slaff, 35, has autism.

photo: David Yellen

For their last field day of summer, the students of the Judge Rotenberg Center, a private boarding school for special-education students in Canton, Massachusetts, have gotten lucky; it is an exquisite afternoon. As cars whiz by the two-building complex, the late-September sun gleams off the basketball backboard and young bodies jostle for position on the asphalt court below. The playground in the middle of the parking lot is empty, but won't be for long: Students who earned their way out of the classroom for good behavior or class performance will get, as reward, a smooth ride on the school's newly assembled swing set.

The only thing that sets these students apart from kids at any other school in America—aside from their special-ed designation—is the electric wires running from their backpacks to their wrists. Each wire connects to a silver-dollar-sized metal disk strapped with a cloth band to the student's wrist, forearm, abdomen, thigh, or foot. Inside each student's backpack is a battery and a generator, both about the size of a VHS cassette. Each generator is uniquely coded to a single keychain transmitter kept in a clear plastic box labeled with the student's name. Staff members dressed neatly in ties and green aprons keep the boxes hooked to their belts, and their eyes trained on the students' behavior. They stand ready, if they witness a behavior they've been told to target, to flip open the box, press the button, and deliver a painful two-second electrical shock into the student at the end of the wire.

Surveying the seemingly cheery outdoor scene is the school's founder and executive director, Matthew Israel. A trim 73-year-old with a head of curling white hair, Israel wears a gray sports coat over a black shirt and black-and-white-striped tie. The Harvard-educated psychologist speaks in soft tones, but he offers a full-throated defense of the skin shock treatments provided by his school, which Israel says derive from the teachings of his mentor, the famous and controversial behavioral psychologist B.F. Skinner.

Israel has about 230 "clients"—full-time students at the Rotenberg Center—who are mentally retarded, developmentally disabled with diseases like autism, or have been diagnosed with ailments such as depression, schizophrenia, or conduct disorder. Most come to this complex south of Boston from New York, but some travel from as far away as California. Many of them come not in spite of the skin shocks, but because of them. The Judge Rotenberg Center or JRC is the only school in the country that uses that type of behavioral therapy, and has come under fire from those who find its techniques cruel and unusual.

"They don't really understand," Israel says of critics who oppose his use of painful physical punishments—called "aversive stimuli"—to control behavior. "The students with whom we use the skin shock are students who can't be served anywhere else."

Over the past 35 years, Israel has repelled several attempts by regulators and legislators to shut his school down, and has grown to become not only a practitioner of aversive methods but also their champion. Now, yet again, he has a fight on his hands—this time with New York state government. New rules that the New York State Board of Regents adopted this summer on an emergency basis (and could make permanent later this month) ban the use of aversive stimuli—a range of tactics that includes not just skin shocks, but also slapping, ice applications, pinching, strangling, noxious smells and tastes, withholding food, and sleep deprivation—on New York students, even those who travel to Massachusetts to attend the Rotenberg Center.

But the Regents rules won't put Israel out of business, because the regulations allow exceptions for kids who pose a real danger to themselves or others, and for whom all other therapies fail. Opponents of aversive stimuli continue to fight for a total ban. "We are talking about the torture of school children," wrote State Senator Richard Gottfried in a letter to the Regents in August. "If we discovered that these regulations were in place at Guantanamo or Abu Ghraib, no one would have to demand Donald Rumsfeld's resignation."

Meanwhile, Israel wants the loophole opened even wider, to give the Rotenberg Center the freedom to impose its methods on children it deems in need. He recalls some of the children he has treated at JRC—kids who slapped themselves into blindness, or were so violent that a scrum of staff members struggled to hold them down. He remembers patients who rammed their heads onto tables or reached into their rectums to make themselves bleed. Israel claims that the sting of skin shocks made those kids better. In fact, he contends, the pain saved their lives.

Every inch of the Rotenberg Center's two buildings, the play area outside, and the student residences scattered around the area is monitored at all times by surveillance cameras. A team of employees watches the broadcasts from these cameras, and the people watching the cameras are observed by other cameras. The monitors look out for staff abuse and evaluate employees following every shift, to make sure students' treatment plans are followed. Some use the cameras to follow specific students who've been deemed particularly dangerous. Signs of the skin shock treatment are everywhere; the students have their backpacks near at all times, and a staff member might have as many as seven triggers hanging from his or her belt at any given moment.

Despite these hints of danger, it's hard for an outsider to detect the risks. Hillary, with long blond hair framing a soft face behind thick glasses, looks like a typical shy teenage girl—clad in baggy clothes, shrugging when introduced to a stranger, concentrating on a game of computer solitaire. It's only when she's out of earshot that you learn what happened at Hillary's last school, in Florida, where she hid in a bush, then tried to slice a staff member's neck with the jagged edge of a broken CD. When she arrived at the school, Hillary stabbed a staffer in the gut with a pencil. "She's very dangerous," says Sue Parker, the school's head of programming. "She could kill someone."

Parker has been at the Rotenberg Center for two decades, and bears scars from students who scratched her; she has had her ribs cracked three times. "We witness the tremendous progress that they've made," she says, explaining her longevity. "And I really think it's the GED," referring to the Graduated Electronic Decelerator, the shocking device's technical name.

Some of the scariest students never need the shocks; according to staff members, the mere threat of an electric jolt alone snaps them into shape. Other students actually ask to be wired up, say staff members, because they witness the improvement their peers make and the privileges they earn. But other kids don't have to ask. As Israel and Parker lead their tour of the facility, a staff member walks to the bathroom leading a kid wearing protective mitts. Every few steps the kid stops, shouts something inarticulate, then moves on. Finally, he makes it to the toilet.

"Hmmm," Parker frowns.

"Yes," Israel says, "it might be time for the GED."

One thing you won't see at the center is traditional psychological counseling. While students do meet with clinicians, there are no regular appointments or group therapy. School literature states that counseling is done "as needed," but not when it could be seen as a reward for bad behavior, and adds: "The purpose of the counseling is to enhance the student's cooperation with, and progress within the program." You also won't see most students on psychiatric drugs, even though many arrive at the school having tried several of them (one patient had been on 29 different meds) and suffering from side effects like tremors. Israel sees those meds as tools for warehousing students, not treating them.

What you do see here is a lot of color—an avalanche of it. The reception area is full of oversize lime-green chairs, and the walls are hung with bold glass renderings of blooming flowers. All over the school are couches and chairs in pink and yellow, overstuffed and inviting. The walls in the main building are covered top to bottom with bright prints of flowers, while in the newly refinished classroom building the hallways are painted a pleasing dark green. The splashes of color give JRC a lively feel. But there are no traditional classrooms. Each student works on an individualized program that is computer-based; there are no teachers writing math on blackboards or lecturing on American history.

Each classroom, however, is slightly different because JRC students exhibit a range of abilities and behaviors. In a classroom of lower-functioning students, one of the girls can't stop bouncing up and down, and her peers wear mitts to prevent scratching or grunt instead of talk. But down the hall, a higher-functioning class has kids studying chemistry and a girl named Fatima who's starting a job at Bertucci's that afternoon. Other rooms are "alternative learning centers," where extra staff is on hand to monitor kids who are too unruly for regular classes; there are mats on the floor and restraints at the ready because the students are so often wrestled down or bound to a chair.

But in every class the logic of the Skinner Box comes into play. There are rewards for acting the right way. Kids wear cards on their belts, where they collect tokens for good behavior, hard work, or adhering to a "contract" to sit still for a few minutes or get through the morning without acting out. Most classrooms have a "reward box" full of goodies like puzzles and games that the kids can take home, and a "reward corner" where deserving students can watch cartoons for a few minutes at a time. There's also a dazzling "reward room," equipped with a pool table and arcade games, to which the well behaved earn entrance, as well as a "contract store" where students can buy DVDs or handbags with points they've earned for staying on track. Pizza parties, weekly field days, and less restrictive housing placements are also part of its positive programming. There's even a "whimsy room," a magical-looking chamber with color-crowded walls, a cartoonishly enormous chandelier out of a Dr. Seuss book, and a grand table with high-backed chairs made of clear plastic laced with color. The room, which exists for parties, looks like a designer's attempt to paint a picture of fun.

Samantha Shear,an autistic 13-year-old, used to hit herself so hard she detached her retinas.photo: David Yellen

In the early days of his work with aversive stimuli, Israel and his staff used spanking, pinches, muscle squeezes, water sprays, aromatic ammonia, and unpleasant tastes to punish problematic behavior. They still withhold food from some students as an aversive, but shocks are their main treatment. The school began using electric shock in 1989, but the device they first used, called SIBIS, was so weak that many students grew accustomed to it, eroding its effectiveness. So Israel developed the GED, which he registered with the Food and Drug Administration in 1995. (The GED was classified in such a way that it only required FDA registration, not approval.) When students grew innured to that, Israel brought forth the GED-4, three times as powerful as the original GED. That version is not registered with the FDA, which now says the Rotenberg Center is exempt because it's only using the machines in-house. The skin shocks at Rotenberg aren't a form of "electroshock therapy," which involves far more powerful shocks traveling through the brain. The GED-4 sends 45 milliamperes into the surface of the skin, the kind of current that a fairly weak recharger can send to your laptop battery. It's enough to hurt, delivering a rapid, vibrating pain. Some compare the sensation to a strong pinch, a bee sting, or a tattoo needle's bite. "Painful shock, muscular control is lost" is one federal- government shorthand for the experience.

Aside from a momentary tingling, the faint whiff of singed hair, and a couple small pinpoint marks on the skin, a single shock administered to a visitor at Rotenberg didn't produce any lasting physical effects. Five of the kids under Israel's care have died in the 35 years he's run the school, but none of those deaths were linked to aversive therapy. Israel insists the GED is better than the alternatives for his students—debilitating drugs or physical restraints.

**There are around 150 New Yorkers at the Center; 100 or so are from New York City. About half the students at JRC, and half the New Yorkers as well, get skin shocks. The JRC obtains local court approval and an independent psychologist's review before it can physically punish a student. And, Israel says, he always obtains a parent's permission (Parents can even log on to a special website to see how often their kid gets shocked.)

Students usually start by wearing three GED devices so they won't know where the next shock will hit, and won't be able to pull off all the devices at once. A person might wear up to five, but only one operates at a time. Every hour in each classroom, a computerized voice tells the teachers to rotate the GEDs so students don't get zapped repeatedly in the same area. Most students wear GEDs in which the electrodes are right next to each other. But some wear a different version that arrays the electrodes several inches apart, so that the current runs from the palm to the tip of a finger or from the ankle to the ball of the foot, and hurts more—or as the staff puts it, is "more aversive." Students wear the GEDs 24 hours a day. If a student's behavior improves, the GEDs are removed one at a time. Then the student goes GED-free for an hour, then two, and so on, until he or she is completely off the machine. They can always be hooked up again, however, if they lapse.

The goal of the GED, explains Israel, is to deliver punishment immediately so that even a student with a low IQ or a severe psychiatric disorder might be made to understand that whatever he just did was unacceptable. Even kids who hurt themselves, he says, react differently to pain outside their control. Each student has a sheet listing the types of behaviors that prompt a staff member to administer a shock. When one of the target behaviors occurs, the staffer is supposed to confirm with a colleague that a shock is warranted.

While psychologists write the aversive treatment plans for JRC students, it's the school's "mental-health aides"—required only to have a high school diploma, complete a two-week course, and attend regular in-service training—who monitor the classes and do the shocking. With confirmation in hand, the staff member zaps the student and then explains to him why he's being punished.

Sometimes the explanation to the student—and to outside observers—is simple and obvious: no tearing out your hair, no hitting yourself, stop scratching. But sometimes, the reasons are more obscure. Don't raise your hands, no swearing, stay in your seat. In the school's point of view, dangerous behaviors are sometimes preceded by seemingly benign ones. When the school detects a pattern, it might punish the prelude in order to prevent the harmful act. If a student typically slaps the arms of his chair, swears, and stands up before he attacks a teacher, a staffer might shock him when he stands up, when he swears, or perhaps when he slaps the arms of his chair. This approach is valid, say psychologists who defend Israel's approach—as long as whoever is administering the shock is sure that the minor behavior he's punishing is actually a predictor of something serious.

That caution also applies to the automatic shocking devices that the facility sometimes uses. A child who tears his hair out might be told never to put his hands to his head. He might be instructed not to even raise his hands from his sides. To enforce this rule, the center in some cases will rig plastic holsters to the student's hips. He has to keep his hands in the holsters. If he lifts his hands out of them, a device automatically shocks him, and keeps shocking him at one-second intervals until he puts his hands back. The rationale behind the device is that punishment must be immediate to be effective.

But after some serious incidents the student is not punished right away. For example, when a student attacks a staff member in a life-threatening manner, "we don't go to the cops," says Israel. "We don't do that." Instead, Rotenberg Center officials keep both crime and punishment in-house: The student has his hands and feet restrained and is then shocked five times, at random intervals, over a period that can last up to 30 minutes.

Sometimes, the student gets shocked for doing precisely what he's told. In a few cases where a student is suspected of being capable of an extremely dangerous but infrequent behavior, the staff at Rotenberg won't wait for him to try it. They will exhort him to do it, and then punish him. In these behavior rehearsal lessons, staff members will force a student to start a dangerous activity—for a person who likes to cut himself, they might get him to pick up a plastic knife on the table—and then shock him when he does.

Automatic devices, lengthy shocking sessions, and behavior rehearsal lessons are not what typical students receive. Israel says that among the students who get skin shocks, the average is one zap a week. Rarely does someone get shocked as often as 15 times a day, but Israel wouldn't be embarrassed if they did. He's sure it works, recalling one of his toughest cases—a kid who made himself vomit constantly and was at risk of starving to death. "I mean, his life was saved," Israel says. "If we hadn't had the GED, I don't know how we would have kept him alive."

But the GED isn't only used when a life is at stake, or when a student hurts himself or another, but also for "noncompliance" or "simple refusal." "We don't allow individuals just to stay in bed all day," says Dr. Robert von Heyn, a Rotenberg clinician, in a video for parents. "We want to teach people. So we may use the GED to treat noncompliance." Other behavior that doesn't appear dangerous also could earn a zap. While it might seem excessive to shock a student for nagging his teacher, Israel asks, what if the kid nags all the time, every minute, every day? The nagging interferes with his learning, so he can't learn self-control and develop normally. JRC's choice is to shock him, stop the nagging, and let him learn.

Every inch of the Rotenberg facilities is under constant surveillance. Even the people watching the screens are themselves on camera.photo: David Yellen

Amid the black leather couches and abundant glass sculptures in Israel's office, a curious collection of boutique kaleidoscopes is displayed on the coffee table. Peering into each tube, watching the crystals shift together and apart, you see the picture constantly changing. Whether it looks like chaos or beauty depends on the beholder. The decor is fitting: Israel knows that outsiders and laypeople get upset when they see kids getting shocked at JRC, but he says that's because they don't understand the true impact of what they witness. A half-century ago Israel was the one laboring to clear the picture, a college student shifting the shards of 1950s Cold War ideological struggle for an explanation of human behavior, with its stark choice between Communist materialism and democratic capitalism. He discovered another option. "Skinner said a man isn't good or evil," Israel recalled of the philosophy that inspired him. "He's what he's made by his environment and his genetics. . . . Human behavior is lawful."

Before B.F. Skinner, a lot of psychology concerned itself with understanding how the inner workings of the mind affect the way people act. Skinner thought this approach was nonsense; he believed that it was neither possible nor necessary to know what was going on in someone's head; all that mattered was behavior. He wasn't the first psychologist to adopt a behavioral approach, but he took it further than his predecessors. He argued that people's behaviors were purely the product of their environment, specifically of a process called "operant conditioning," in which the consequences of our action determine whether we repeat it: If it's rewarded, we do it again; if not, we stop.

The experiment that most clearly illustrated this was the so-called Skinner Box, a cage in which a rat had a bar to press. If Skinner awarded a food pellet when the rat pushed the bar, the rat would push it again. As Skinner changed the pattern of awards, the rat's behavior changed. Skinner extrapolated the logic of the Skinner Box to society as a whole, believing that all human suffering could be eased through the application of proper conditioning, and even penned a utopian novel in 1948, Walden II, that depicted such a world.

The seeming elegance of Skinner's approach moved Israel to dedicate his life to applying it. After leaving Harvard with a Ph.D. in 1960, Israel started a company to manufacture so-called "teaching machines," one of the technologies Skinner advocated to properly condition young learners. By the late '60s, Israel had started two communes that applied behavioral techniques. But the teaching-machine business was never successful enough to support the communes. So Israel instead launched a school that applied "Skinnerian" techniques to students with severe behavioral problems. The Behavioral Research Institute began in Providence, Rhode Island, in 1971. In the mid 1970s it opened branches in Massachusetts. Israel later changed the school's name to honor a Massachusetts judge, Ernest Rotenberg, who had sided with Israel in a battle against Bay State regulators in the mid 1980s over his use of painful aversive stimuli.

Aversive therapy first emerged in experiments with animals. Then in the 1960s, around the time Skinner's behavioral analysis was dominating psychology, some scientists used aversion to try to "cure" homosexuals. But Skinner was never a major advocate for aversive stimuli. His work concentrated mainly on the use of rewards to encourage good behavior, not punishments to discourage bad conduct. In the world he envisioned in Walden II, Skinner foresaw little punishment. But Israel says Skinner acknowledged that places like JRC were not utopias. JRC does employ a comprehensive program of positive reinforcement, consisting of those prizes and privileges that students can earn for the simplest tasks. But for Israel, punishments are just the flip side of rewards.

That view is not universal. The American Association for Mental Retardation calls aversive therapies "inhumane" and wants them eliminated. The New York Civil Liberties Union seeks a total ban in New York, dubbing aversive therapies "outmoded and ineffective." But while there's not an abundance of research on the effectiveness of skin shocks because of the ethical issues involved with shocking human subjects, many psychologists believe that in a very few, very serious instances of dangerous behavioral problems, skin shocks might be a legitimate therapy option. "Only in your most extreme cases where there's a threat of harm would you use it," says Kathryn Potoczak, a professed Skinnerian psychologist at Shippensburg University, a public college in Pennsylvania. She, like many psychologists, believes the choice in those cases is between shocking patients and allowing them to hurt themselves so severely they might die.

Matthew Israel, a disciple of pioneering behaviorist B.F. Skinner, started two communes before he launched the Rotenberg Center. He believes the painful punishments that his staff administers have saved students' lives.photo: David Yellen

Students who end up at the Rotenberg Center usually begin their educations in a local school district's special-education programs. When regular schools cannot handle a child, local officials and parents look for private school options, including those out of state. No matter where the child goes, the state assumes the cost, under its obligation to provide a sound education for everyone until the age of 21. (Most students return to New York once they reach 21, but there are 24 New York adults who've remained at Rotenberg.)

The Rotenberg Center—with an annual tuition of $214,000—has been positioned as the program of last resort: It doesn't automatically reject anyone except for sex offenders and those with very serious medical conditions. Many of its students were thrown out or refused by other schools.

That's what happened to Samantha, a 13-year-old with autism from Roslyn Heights who has been at the school since March 2005. "We had her in four different schools and they tried all kinds of therapy, all kinds of positive behavioral therapy, and we had various therapists coming all over the house and it basically didn't work," says her father, Dr. Mitchell Shear, an internist who practices in the Bronx. "She became more aggressive. She would bite and scratch people. She was basically constantly crying." She also smacked herself in the head so hard she detached both retinas. The Anderson School in Purchase, where she'd been staying, said they couldn't handle Samantha anymore. A person at Anderson recommended Rotenberg to the Shear family.

The Shears' desperation resembles that of Bronx resident Lorraine Slaff 18 years ago. Slaff's autistic son Matthew had troubles early; she recalls having to pad his crib because he kept ramming his head into the sides. As he grew up, he began banging his head on sharp points like the corner of a table, bashing deep holes into his scalp. When he was home, Slaff didn't sleep for fear that she'd miss the sound of her son trying to do himself harm. When other facilities told Slaff that they couldn't handle her then 17-year-old boy, Rotenberg offered itself as a willing alternative. The catch: Slaff would have to consent to her child being subjected to physical pain. Shear faced the same choice. Neither parent blinked. "It didn't bother me because I thought he was going to die," recalls Slaff. "There was nothing else." Matthew's twin, Stewart, is also autistic, but exhibited symptoms later than his brother, and now Slaff believes Stewart would benefit from aversive therapy. But she cannot obtain that treatment for him in New York—because adult facilities here don't use aversives—or get him into the Rotenberg Center. While some children remain at the center after they reach adulthood, the state does not place adults there.

While many psychologists agree with Israel that aversive therapy can work as a last resort in a very few cases to control dangerous behaviors—the school contends that the skin shocks are almost 100 percent effective in reducing those—there's less consensus on whether a method like skin shocks can really cure someone.

Israel's theory is that by shocking to discourage dangerous behavior, the therapist buys time to use positive approaches that teach patients how to control themselves. But evaluating whether the school has succeeded with students is difficult because they arrive with such different talents and troubles. Higher-functioning students—those with normal IQs but severe emotional problems, who constitute about half the school—can have normal lives: The center's website features testimonials from kids who have joined the Marines, or have been the first in their family to complete high school, or have even gone on to college.

Other students are severely mentally retarded or developmentally disabled, and have no such prospects. "They're never going to be normal, fruitful taxpayers, but they can have some dignity and happiness," says Israel. A student named Caroline, who is in her thirties and has lived at the facility for more than 20 years, still wears a protective helmet and requires one-on-one staff monitoring, but JRC staff consider the fact that she's still alive a measure of success. Slaff's son Matthew also remains at JRC. He has stopped banging his head and can take vacations with his mom, but he still hurts himself sometimes, and still wears the GED.

Shear says he and his wife only visit their daughter once every six weeks or so; he doesn't know how long Samantha will be there. He does know the limits of optimism. "She'll never be cured of what she has. Her mental capacity will never approach that of a normal person," he says. "I believe that the GED will eventually come off her and she'll be able to maintain control of her behavior and be happy because she's not hurting herself or crying all the time."

Shear believes Samantha has already come a long way in her time at the Rotenberg Center. "I mean, when we went up last time," he says, "she was actually happy."

But after visiting the Rotenberg Center this spring, New York state inspectors concluded that "the background and preparation of staff is not sufficient," that JRC shocks students "without a clear history of self-injurious behavior," and that it uses the GED "for behaviors that are not aggressive, health dangerous, or destructive, such as nagging, swearing, and failing to keep a neat appearance." What's more, the inspectors said, the program for withholding food raised health concerns, and the classroom instruction was substandard.

Israel says the inspection was conducted by psychologists biased against his methods. But the New York report is just the start of JRC's current troubles. The Massachusetts agency (all JRC's operations have been located in the Bay State since 1996) that licenses JRC will inspect the school in coming months to see if requirements it imposed after a 2003 visit have been met. A separate Massachusetts agency has referred an allegation of abuse at JRC to local police; the claim is that the GED burned a student. Meanwhile, a Long Island mother whose son Antwone was treated at the JRC has sued her local school board and the center for using aversive therapy that allegedly caused the boy "serious physical injuries and mental anguish." At the same time, the New York legislature is considering a new bill that would ban skin shock outright on New York students.

Then there are the Regents regulations, which were prompted by the spring inspection. They prohibit all aversive stimuli but permit certain limited exceptions. Israel says the New York rules would tie his hands by restricting the skin shocks to kids who are endangering their lives or others— preventing shocks in cases of "health dangerous" behavior. The rules also bar automatic shocks. A group of JRC parents who agree with Israel went to federal court this summer to stop the imposition of the new rules on their children. The case is still pending, but the judge did block some of the rules temporarily for the students whose parents sued. Israel says that other New York kids who are no longer getting skin shocks are regressing.

But if that's true, it only fuels Israel's critics who say that all he's doing is hurting kids, not curing them. "This isn't a bell ringing. This is somebody getting an electric shock. It hurts them, so they stop," says Beth Haroules, a staff attorney at the NYCLU. "But if you take away the pain device, they haven't learned to stop what they're doing."

Even the center's aggressive methods— like automatic shocks and behavioral rehearsal lessons—have some scientific support. But the endorsements are cautious, and limited only to cases where painful techniques are the only hope—and where they work. Experts note that there is a "slippery slope" risk with aversives: If they work for a very serious behavior, why not use them for a slightly less serious one? And then there's the question posed by partial success: If skin shocks reduce a behavior but don't eliminate it, do you keep shocking for months, years, or even decades? The scientific process of peer review could address some of these questions. But many practitioners admit that when it comes to aversives, pure science isn't the only issue. The ethical limits on how to use science are also in play.

The GED, or Graduated Electronic Decelerator, sends a two-second jolt into a studentï¿½s skin. Itï¿½s painful but does no lasting damage, the Rotenberg Center contends.photo: David Yellen

Albany's recent regulatory attention to his practices puzzles Israel. "It isn't as if we just started to do something unusual," Israel says. "We've been doing the service since the 1970s for New York." So why is the state only acting now?

People on all sides of the debate over aversives ask the same question. New York showed some concerns about the school's approach in the '70s and '80s; the state balked at paying for the school until parents sued. But it wasn't until this summer—with a lawsuit in the mix—that the New York State Education Department moved to regulate the use of aversive techniques on its students. (While the Rotenberg Center is the only place where New York students get skin shocks, two private preschools that New Yorkers attend—one near Albany and the other in Maine—use noxious tastes like lemon juice to punish kids.) The New York State Office of Mental Health bars any aversive techniques. Eleven other states already ban or restrict aversive therapies. And while psychologists largely support the validity of aversive methods, practitioners generally believe that such techniques must be used sparingly and very carefully. But only now is New York attempting to control their use.

Rebecca Cort, who oversees special-education placements for the state education department, says the need for rules only became apparent in 2005 when New York did a routine inspection of the institution. "A much higher number and percentage of students who were coming from New York State were being placed on aversive intervention," she says. That's partly because in the past couple years, the number of New Yorkers going to the school has swelled—but not necessarily because their behaviors led other schools to pass on them. "It was that the in-state beds were full," Cort says. "They were getting a larger number of students because of a lack of capacity in New York State."

Cort says the state is trying to build beds here, prodded by the legislature to do so. The alleged abuse of a New York man named Vito "Billy" Albanese, who'd suffered a traumatic brain injury, in a New Jersey facility a few years ago prompted state lawmakers in 2005 to pass the so-called "Billy's Law," which tries to tilt special- education placements toward in-state facilities.*** That's how the new regulations have to be seen—not just regulating Rotenberg, but erecting a framework for someday treating some of the worst behavioral disorders within New York's borders.

Given that context, some say the Regents have built a flawed framework. The New York State Psychological Association says the rules "effectually legalize corporal punishment." More than one New York school district is being sued for the use of "time-out rooms," but the new rules permit them. And there's not much confidence that the state education department—which only last year was found to have put residents at its School for the Blind in "immediate jeopardy to individual's health or safety"—is up to the task of handling people who, had they gone to the Rotenberg Center, would have received the treatment of last resort.

Schools using skin shock could open here. Or the Rotenberg Center could move to New York State, an option Israel says he has considered. But even though Cort says there's no move to take the Rotenberg Center off the approved list of out-of-state facilities, Israel claims the state's education department now discourages parents from placing their children with him. Even if he had a branch of JRC inside New York, Israel acknowledged by e-mail, the hostility toward the Rotenberg Center would not change. And so, unless lawmakers or regulators stop his practices, Israel and his school will remain where they are, and the shocks will continue.